Complications of Acrylic Nails: A Comprehensive Medical Overview

Acrylic nails have become a popular cosmetic enhancement for millions of people worldwide, particularly in the beauty and fashion industries. Many individuals seek acrylic nails for their durability, long-lasting nature, and aesthetically pleasing appearance. However, despite their widespread use, acrylic nails can be associated with several complications, ranging from minor allergic reactions to more severe infections and long-term damage to the nail bed.

In this comprehensive review, we will explore the various complications associated with the use of acrylic nails. We will examine the pathophysiology behind these complications, diagnostic approaches, preventive strategies, and treatments, providing healthcare professionals with an in-depth understanding of the potential risks associated with acrylic nails. This knowledge is critical for advising patients on safe practices and managing any adverse reactions.

1. What Are Acrylic Nails?

Acrylic nails are synthetic nail enhancements that are applied to the natural nails. They are created by combining a liquid monomer (ethyl methacrylate or methyl methacrylate) with a powder polymer to form a durable plastic layer. The mixture hardens once applied to the nail, providing strength and length. While acrylic nails offer cosmetic appeal and functional benefits (such as reinforcing weak nails), their application, maintenance, and removal can lead to several complications.

2. Common Complications of Acrylic Nails

While acrylic nails are generally safe when applied by a trained professional, several complications can arise. These complications may range from mild, temporary discomfort to more severe, chronic conditions requiring medical intervention.

1. Allergic Reactions

Allergic reactions to acrylic nails are one of the most common complications. The chemicals used in acrylic applications, particularly ethyl methacrylate (EMA) and methyl methacrylate (MMA), can provoke an allergic response in some individuals.

• Symptoms: Redness, itching, swelling, blistering, or a rash around the nail bed, cuticles, or fingers are typical signs of an allergic reaction. The surrounding skin may become inflamed, and in severe cases, contact dermatitis can extend to other parts of the hands or body.
• Pathophysiology: MMA, a component that has been banned in some countries due to its high potential for allergic reactions, is still used by certain salons. MMA molecules are smaller than EMA molecules, which increases their ability to penetrate the skin and initiate an immune response. When the immune system identifies these chemicals as foreign substances, it triggers inflammation and other allergic symptoms.
• Management: Treatment typically involves removing the acrylic nails and avoiding further exposure to the allergen. Topical corticosteroids or antihistamines may be prescribed to manage the inflammation and itching. If the symptoms persist or worsen, a dermatologist referral may be required.

2. Fungal and Bacterial Infections

Infections are another common complication of acrylic nails, particularly fungal (onychomycosis) and bacterial infections. The process of applying acrylic nails often involves filing down the natural nail, which can leave the nail bed vulnerable to pathogens.

• Fungal Infections: Onychomycosis occurs when fungi, such as Trichophyton rubrum or Candida, invade the space between the acrylic nail and the natural nail bed. Symptoms include thickened nails, discoloration (yellow, brown, or green), and crumbling or flaking of the nail surface.
• Bacterial Infections: The most common bacteria associated with acrylic nail infections are Pseudomonas aeruginosa, which can cause green nail syndrome, characterized by a greenish discoloration of the nail plate. Other bacteria, such as Staphylococcus aureus, can also cause infections, leading to redness, swelling, pain, and purulent discharge.
• Pathogenesis: Acrylic nails create an occlusive barrier, trapping moisture between the artificial and natural nails. This warm, moist environment is ideal for fungal and bacterial growth. Additionally, improper application or lifting of the acrylic nail can create spaces where pathogens can proliferate.
• Management: Fungal infections are treated with topical or oral antifungal agents (such as terbinafine or itraconazole), while bacterial infections may require topical or systemic antibiotics. In severe cases, removal of the acrylic nail is necessary to allow proper treatment of the underlying infection.

3. Nail Bed Damage

Acrylic nails can cause significant damage to the natural nail bed, particularly with repeated applications or improper removal.

• Thinning of the Nail Plate: The process of filing down the natural nail before applying acrylics can weaken the nail plate. Over time, this thinning makes the nails more fragile and prone to splitting, cracking, or breaking. Thinning may also occur if the acrylic nails are forcibly removed rather than soaked and gently lifted off.
• Separation of the Nail Plate (Onycholysis): Onycholysis refers to the separation of the nail plate from the nail bed, a complication often seen in individuals who wear acrylic nails for extended periods. The separation creates a space that can become infected with bacteria or fungi.
• Management: Resting the nails by discontinuing acrylic applications and allowing the natural nails to grow out is crucial. Strengthening nail polishes or biotin supplements may be recommended to improve nail health. In cases of severe damage or onycholysis, treatment with antifungals or antibacterial agents may be necessary.

4. Traumatic Injuries

Acrylic nails are significantly harder than natural nails, making them prone to traumatic injuries if force is applied. Common traumatic injuries include:

• Nail Avulsion: When an acrylic nail is caught on an object or subjected to blunt force, the entire nail plate can be forcibly detached from the nail bed. This painful injury exposes the sensitive nail bed and may take months to heal.
• Nail Fracture: The rigidity of acrylic nails makes them less flexible than natural nails, increasing the risk of breakage. A fractured acrylic nail can damage the underlying natural nail, causing pain and bleeding.
• Management: In cases of nail avulsion, immediate first aid is necessary to prevent infection. The area should be cleaned, and an antiseptic applied. In severe cases, surgical intervention may be needed to repair the nail bed. Patients should be advised to avoid wearing acrylic nails during the healing process.

5. Contact Dermatitis

Beyond allergic reactions, prolonged exposure to the chemicals used in acrylic nails can cause irritant contact dermatitis, especially in nail technicians and frequent users.

• Symptoms: Redness, dryness, and cracking of the skin around the nails, cuticles, and fingers are common symptoms. Some individuals may experience more severe reactions with oozing blisters and itching.
• Pathogenesis: Irritant contact dermatitis is caused by repeated exposure to the chemicals in acrylic nails, such as ethyl methacrylate, acetone, and other solvents used during application and removal. Prolonged exposure can break down the skin's protective barrier, leading to irritation.
• Management: Treatment involves identifying and eliminating the irritant, using emollients to restore the skin barrier, and applying topical corticosteroids to reduce inflammation. In chronic cases, referral to a dermatologist may be necessary for patch testing and further management.

6. Respiratory Issues in Nail Technicians

Nail technicians who are regularly exposed to the fumes and dust from acrylic nail products may experience respiratory complications. The chemicals in acrylic nails, particularly methyl methacrylate (MMA) and ethyl methacrylate (EMA), can release fumes that irritate the respiratory system.

• Symptoms: Common symptoms include coughing, wheezing, shortness of breath, and irritation of the throat and nasal passages. Chronic exposure may lead to more severe conditions, such as occupational asthma or chronic bronchitis.
• Pathogenesis: Prolonged inhalation of volatile organic compounds (VOCs) and dust particles from acrylic products can irritate the respiratory tract and trigger an inflammatory response. In individuals with pre-existing respiratory conditions, such as asthma, the fumes can exacerbate symptoms.
• Management: Prevention is key for nail technicians. Adequate ventilation, the use of high-quality dust extractors, and wearing masks can significantly reduce exposure to harmful chemicals. In cases where respiratory symptoms persist, referral to a pulmonologist for further evaluation and management may be necessary.

7. Chemical Burns

Chemical burns can occur during the application or removal of acrylic nails, especially if acetone or other solvents come into prolonged contact with the skin or if the chemicals used are too strong.

• Symptoms: Redness, pain, blistering, and peeling of the skin around the nails may indicate a chemical burn.
• Pathogenesis: Acetone and other solvents can be highly irritating to the skin, especially when used improperly. If the skin barrier is compromised, these chemicals can penetrate deeper layers, causing burns.
• Management: Immediate care for chemical burns involves thoroughly rinsing the affected area with water and applying a topical soothing agent. In more severe cases, burn ointments or medical care may be required.

3. Preventive Strategies for Acrylic Nail Complications

While complications from acrylic nails are common, several preventive strategies can help minimize risks:

• Proper Application and Removal: Always have acrylic nails applied and removed by trained professionals. Avoid nail salons that use banned substances like methyl methacrylate (MMA), as these can increase the risk of allergic reactions and long-term damage.
• Adequate Hygiene: Proper hygiene during application can prevent infections. This includes disinfecting tools, keeping work surfaces clean, and ensuring that nail technicians wash their hands and wear gloves.
• Regular Breaks: Advising patients to take regular breaks from wearing acrylic nails allows the natural nails to recover and reduces the risk of nail bed damage and infections.
• Avoid Trauma: Encourage patients to be cautious with their acrylic nails to avoid trauma. This includes avoiding situations where the nails might be subjected to excessive force.
• Sun Protection: For individuals prone to allergic reactions or those who frequently use UV lamps to cure acrylic nails, sun protection (using sunscreen on the hands) may help reduce the risk of UV-related skin damage.
• Education: Educating both patients and nail technicians about the potential risks of acrylic nails can lead to better practices, safer applications, and healthier outcomes.

Conclusion

Acrylic nails, while popular for their aesthetic and functional benefits, are not without risks. Complications such as allergic reactions, infections, nail bed damage, and respiratory issues pose significant concerns, particularly for individuals who wear acrylics frequently or nail technicians exposed to chemicals on a daily basis.

As healthcare professionals, it is essential to remain aware of these complications and provide guidance to patients seeking nail enhancements. Preventive measures, proper hygiene, and timely management of adverse reactions can help reduce the risks associated with acrylic nails and ensure that patients can enjoy their cosmetic benefits safely.